The brainstem is located directly above the spinal cord. It helps control involuntary functions like heartbeat, breathing, and blood pressure. Normal brainstem function is vital to survival. Nerves that are used for eye movement, hearing, talking, chewing, swallowing, and muscle movement are also controlled by the brainstem.
A brainstem stroke happens when the blood supply to the brainstem is interrupted. This type of stroke can result in death, since the damaged brainstem can no longer control the body’s vital functions.
An ischemic stroke is caused by a blockage of the blood flow, which may be due to:
A hemorrhagic stroke is caused by a burst blood vessel. Blood spills out of the broken blood vessel and pools in the brain. This interrupts the flow of blood and causes a build up of pressure on the brain.
Certain factors increase your risk of stroke, but can not be changed, such as:
Other factors that may increase your risk can be changed such as:
Certain medical condition that can increase your risk of stroke. Management or prevention of these conditions can significantly decrease your risk. Medical conditions include:
Risk factors specific to women include:
The symptoms of a brainstem stroke can be severe and may include:
If you or someone you know has any of these symptoms, call for emergency medical services right away. Brain tissue without blood flow dies quickly. Early care can decrease damage.
Since this is an emergency, the doctor will make a diagnosis as quickly as possible. An exam of your nervous system will be done.
Your bodily fluids may be tested. This can be done with blood tests.
Images may be taken of your bodily structures. This can be done with:
Your kidney and liver function will also be tested.
Immediate treatment is needed to:
If needed, steps may be taken to help support your heart and lungs. A tube may be placed into the windpipe to provide oxygen.
For an ischemic stroke, medication may be given to:
For a hemorrhagic stroke, the doctor may give medication to:
These procedures may be done to treat an ischemic stroke:
For a hemorrhagic stroke, a clip or tiny coil may be placed on the aneurysm to stop it from bleeding.
When your condition is stabilized, a feeding tube may be placed to deliver nutrients.
Brainstem strokes can lead to serious deficits. Therapy programs focus on regaining as much ability as possible:
Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:
American Heart Association
National Stroke Association
Heart and Stroke Foundation of Canada
Association of Ottawa
Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(1):227-276.
Hemorrhagic stroke. National Stroke Association website. Available at: http://www.stroke.org/understand-stroke/what-stroke/hemorrhagic-stroke. Accessed November 18, 2014.
Hemorrhagic strokes (bleeds). American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/Hemorrhagic-Strokes-Bleeds_UCM_310940_Article.jsp. Updated September 16, 2014. Accessed November 18, 2014.
Intracerebral hemorrhage. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115590/Intracerebral-hemorrhage. Updated April 11, 2016. Accessed September 30, 2016.
Ischemic strokes (clots). American Stroke Association website. Available at:American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp#.Vk3ipE2FPIU. Updated August 29, 2014. Accessed November 18, 2014.
Jensen M, St. Louis E. Management of acute cerebellar stroke. Arch Neurol. 2005;62(4):537-544.
Long-term management of stroke. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T900125/Long-term-management-of-stroke. Updated February 16, 2016. Accessed September 30, 2016.
Mena F, Fruns M, Contreras A, Soto F, Mena I. Acute brainstem infarct: multidisciplinary management. Alasbimn Journal website. Available at: http://www.alasbimnjournal.cl/revistas/5/mena5.htm. Published October 1999. Accessed November 18, 2014.
Neuroimaging for acute stroke. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T474350/Neuroimaging-for-acute-stroke. Updated January 6, 2016. Accessed September 30, 2016.
Recognizing stroke. National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=SYMP. Accessed November 18, 2014.
Stroke (acute management). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T143427/Stroke-acute-management. Updated December 28, 2015. Accessed September 30, 2016.
Subarachnoid hemorrhage. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116453/Subarachnoid-hemorrhage. Updated July 11, 2016. Accessed September 30, 2016.
2/7/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T566761/Prevention-of-stroke: Bushnell C, McCollough LD, Awad IA, et al. Guideline for the prevention of stroke in women. Available at: http://stroke.ahajournals.org/content/early/2014/02/06/01.str.0000442009.06663.48. Accessed November 18, 2015.
6/2/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T580145/Stroke-rehabilitation: Myint PK, Cleark AB, Kwok CS, et al. Bone mineral density and incidence of stroke: European prospective investigation into cancer-Norfolk population-based study, systemic review, and meta-analysis. Stroke. 2014;45(2):373-382.
6/2/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T361037/Risk-factors-for-stroke-or-transient-ischemic-attack: Imfeld P, Bodmer M,Schuerch M, Jick SS, Meier CR. Risk of incident stroke in patients with Alzheimer disease or vascular dementia. Neurology. 2013;81(10):910-919.
8/11/2015 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T184935/Cardiovascular-disease-and-obstructive-sleep-apnea: Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015;70(9):888-895.
Last reviewed November 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.